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NPI Code Detail

MEDICARE: DR. IRVIN MICHAEL WIESMAN MD

MEDICARE: DR. IRVIN MICHAEL WIESMAN MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208200000XPlastic Surgery Physician036095961IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
201633365OTHERBCBS

General Provider Information

NPI Number : 1194897587
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. IRVIN MICHAEL WIESMAN MD
Provider Business Mailing Address
First Line : 712 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-3818
Country : US
Telephone Number : 312-981-1290
Fax Number : 312-981-1292
Provider Business Practice Location Address
First Line : 712 N DEARBORN ST
Second Line :
City : CHICAGO
State : IL
Zip : 60654-3818
Country : US
Telephone Number : 312-981-1290
Fax Number : 312-981-1292
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2006
Last Update Date : 06/11/2015

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